GIRL SCOUTS OF RIVERLAND COUNCIL_ INC

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					                 Girl Scouts of Riverland Council
                 2710 QUARRY ROAD • LA CROSSE, WISCONSIN 54601
                 PHONE: (608) 784-3693 TOLL FREE: 1-(800)-787-2688
                 WEB: WWW.GSRIVERLAND.COM

                                           PARENT PERMISSION
(This form needs to be completed and signed when meeting outside the regular meeting time and place. Example:
Your troop meets on Tuesday nights and you have a field trip on Saturday.)

Group/Troop # __________ is planning:
               A day outing/field trip to_________________________________________
               An overnight/camping event at ____________________________________
                 Date(s):________________________________________
                 Meet at(location):________________________________
                 Time:__________________Return:_________________
                 Cost:__________________per girl
                 What to bring/wear:______________________________________________________
The leaders/adults in charge: ______________________________Phone _____________________
                              ______________________________Phone______________________
In case of emergency, or change of plans, they will call you at the number listed below. If you need to
contact the group for emergencies only while they are away, please call __________________________
At ________________________. She/he will have the troop itinerary and emergency numbers.
Parent/ guardian, keep this portion for your information. Return the bottom portion to the leader
                                               by__________.
                                     (Return even if girl is not attending)

    -----------------------------CUT HERE----------------------------
                                             PERMISSION SLIP

My daughter (full name)_________________________________________has permission to attend the
group outing to ___________________________________on (date)__________________________, we
can be reached by phone at___________________________.
I will make sure she does not attend if she is not feeling well and I will let you know. If her physical
activity is to be limited in any way, or if she has allergies which may affect her it is noted here:
Allergies: ________________________________________
           _________________________________________
Medication (please complete medication permission on the back of this form)

I give permission for any emergency medical action which may be needed (including x-rays. Our family
doctor’s name is __________________________________, phone_________________________.

Check:                   I will drive
                         Valid driver’s license number__________________________
                         Current auto insurance carrier__________________________
                         I will chaperone
                         Fee for outing enclosed/attached
                         My daughter will not attend this group outing (return even if girl not attending)

Parent/Guardian Signature__________________________________________Date________________
                                                    -over-

                                                                                                    Revised 7/03
Optional: Fill out if this applies for special activities and/or group overnights.

        Sleeping bag or bed roll                           *Flashlight
        Pajamas & pillow                                   Change for phone/vending machines
        Clothing for 2 days/nights                         *Insect repellent – no aerosol cans!
        Jacket & sweater or sweatshirt                     Sun screen
        Raincoat, hat, boots                               Backpack & sit upon
        Extra shoes                                        Camera – optional
        Towel, soap, deodorant                             Garbage bag for wet items
        Toothbrush & toothpaste                            Activities for quiet/free time (cards, books,
        Comb & brush                                       travel games)
        Sanitary items (if needed)                         Other:______________________________
        Unbreakable/washable plate, cup
        Knife, fork, spoon

*Only needed for troop camping                     All items should be packed in bedroll or overnight bag.


Extended Trip Itinerary:




                    PERMISSION FOR ADMINISTERING MEDICATION


The adults in charge of this outing have my permission to administer the following medication to my
child:

Medication:
Dosage to be given:
Date(s) to be given:
Time(s) to be given:
Parent/Guardian Signature:
Date:




                                                                                                 Revised 7/03

				
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